| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
1,647 |
1,626 |
$63K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,763 |
1,713 |
$38K |
| V2020 |
Frames, purchases |
2,585 |
2,523 |
$35K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,740 |
1,687 |
$17K |
| 92004 |
|
474 |
466 |
$16K |
| 92340 |
|
114 |
114 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
50 |
50 |
$2K |
| 92015 |
|
311 |
308 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
96 |
89 |
$1K |
| V2750 |
Anti-reflective coating, per lens |
165 |
165 |
$24.00 |